Morpot skizoafektif tipe depresi

8/13/2019 Morpot skizoafektif tipe depresi

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SUPERVISOR

dr. Sabar P. Siregar, Sp.KJ

MORNING REPORTWednesday Afternoon, February 5th 2014



I. PATIENT’S IDENTITY

AutoanamnesisName : Mrs. R

Age : 39 years old

Gender : Female

Address : Tangerang, BantenOccupation : unemployed

Marital status : Married

Last education : Elementary school

Alloanamnesis

Name : Mr SAge : 40 years old

Relation : Husband



REASON WHY PATIENT

BROUGHT TO HOSPITAL



*

Haven’t got a child for

10 years



*Present History

Still working as a housewife,Social life still good, but patient more

spending her time in her house

utilization of leisure time still good ;

patient love to sewing and making

clothes

Self grooming still good; patient still eatwell, and taking a bath daily

Didn’t work even as ahousewife

Social withdrawal

Poor utilization of leisure time

Self grooming still good: patient

still eat well and taking a bathdaily

Stop Working, thecompany’s bankrupt.Patient become more quite,and often daydreaming.

Patient easily got angry ifsomebody didn’t full fillwhat she needed especiallywith her husband

Patient become more oftenget mad. She even ran intoher neighbor with carrying aknife. Patient become morequite, and sometimes crying

especially when she’spraying.

Her husband sometimes saidthat she’s talking to her self

6 months ago

1 weeks ago



*Present History

Didn’t want to work even as a

housewife,

Poor utilization of leisure time :

patient spent lots of time with

daydreaming

Social withdrawal

Self grooming still good ;

patient still take a bath dailyand eat well

The symptoms worsened.

Patient refused to talk

Sleep disturbance >>

Day ofadmission



• Never been hospitalized beforePsychiatryhistory

• Hypertension (-)• Head injury (-)

• Convulsion (-)

• Asthma (-) • Allergy (-)

Generalmedical history

• Drugs consumption (-)

• Alcohol consumption (-)

• Cigarette Smoking (-)

Drugs andalcohol abusehistory and

smoking history



* EARLY CHILDHOOD PHASE (0-3 YEARS OLD)

Psychomotoric (UNVALID DATA)

• There were not get important data on patients growth and development such as:

• first time lifting the head (3-6 months)

• rolling over (3-6 months)

• Sitting (6-9 months)

• Crawling (6-9 months)

• Standing (6-9 months)

• walking-running (9-12 months)

• holding objects in her hand(3-6 months)

• putting everything in her mouth(3-6 months)

Psychosocial (UNVALID DATA)

• There were not get important data on which age patient

• started smiling when seeing anothers face (3-6 months)

• startled by noises(3-6 months)

• when the patient first laugh or squirm when asked to play, nor playing claps with others (6-9 months)

Communication (UNVALID DATA)

• There were not get important data on when patient started babbling. (6-9 months)



Emotion (UNVALID DATA)There were not get important data of patient’s reaction when playing,

frightened by strangers, when starting to show jealousy or

competitiveness towards others and toilet training.

Cognitive (UNVALID DATA)

There were not get important data on which age the patient can

follow objects, recognizing his mother, recognize her family members.

There were not get important data on when the patient first copied

sounds that were heard, or understanding simple orders.



* INTERMEDIATE CHILDHOOD (3-11 YEARS OLD)

Psychomotor (UNVALID DATA)

not get important data on when patient’s first time playing traditional games

such as hide and seek, glass ball, or if patient ever involved in any kind of

sports.

Psychosocial (UNVALID DATA)

not get important data on patient interaction with her surrounding, not getimportant data on when patient first entered primary school, how well she

play with her new friend on first day school.

Communication (UNVALID DATA)

not get important data regarding patient ability to make friends at school

and how many friends patient have during his school periodEmotional (UNVALID DATA)

not get important data on patient’s adaptation under stress, any incidents of

bedwetting were not known.

Cognitive (UNVALID DATA )

not get important data on patient’s cognitive.





* ADULTHOOD

Educational HistoryElementary School

Occupational historyex tailor. She didnt worked again

because her company is bankrupt

Marital Statushad been married for 10 years but didnt

had a child or never been pregnant

before

Criminal HistoryNo

Social ActivityPatient had introvert personality, but still

had a good social life with the

neighbours.

Current Situationshe lived in jakarta with her husband, she

had a harmonic life, and had been

separated with her family by her choice.



*Family history

*Patient is the 7th childs of 8 siblings.

*There’s no psychiatry history in the family.

Family history





Genogram





*Progression of disorder

Symptom

Role function

february 2014August2013



Mental State

(Wednesday, 5 th February 2014)

Appearance

• A woman, appropriate to her age, completely

clothed, self grooming still good.

State of Consciousness

• Clear

Speech

• Quantity : decreased

• Quality : decreased



Behaviour

Hypoactive

Hyperactive

Echopraxia

Catatonia Active negativism

Cataplexy

Strereotypy

Mannerism Automatism

Command automatism

Mutism

Acathysia

TicSomnabulism

Psychomotor agitation

Compulsive

Ataxia

Mimicry

Aggresive

Impulsive

Abulia



TTITUDE

Cooperative

Non-cooperative

Indiferrent

Apathy

Tension

Dependent

ActivePassive

Infantile

Distrust

Labile

RigidPassive negativism

Catalepsy

Cerea flexibility

Excitement



Emotion

Mood

• Dysphoric• Elevated

• Euphoria

• Expansive

• Irritable

• Agitation

• Can’t be assessed

Affect

• Appropriate • Inappropriate

• Restrictive

• Blunted

• Flat• Labile



Disturbance of perception

Hallucination

• Auditory (+)• Visual (+)

• Olfactory (-)

• Gustatory (-)

• Tactile (-)• Somatic (-)

Illusion

• Auditory (-)• Visual (-)

• Olfactory (-)

• Gustatory (-)

• Tactile (-)• Somatic (-)

Depersonalisation (-) Derealisation (-)



Thought progression

Quantity

• Logorrhea

• Blocking

• Remming • Mutisme

• Talkative

Quality

• Irrelevan answer

• Incoherence

• Flight of idea

• Coherent • Poverty of speech

• Loosening of association

• Neologisme

•Circumtansiality• Verbigrasi

• Perseverasi

• Sound association

• Word salad

• Echolalia



Content of thought

Idea of Reference Over-valued idea

Preoccupation

Obsession

Phobia

Delusion of Persecution

Delusion of Reference

Delusion of Envious

Delusion of Hipochondry

Delusion of magic-mystic

Delusion of grandiose

Delusion of Control

Delusion of Influence

Delusion of Passivity

Delusion of Perception

Thought of Echo

Thought ofInsertion/withdrawal

Thought of Broadcasting

Cant be assessed.







Impulse control whenexamined

• Self control: enough

• Patient response toexaminers question:poor

Insight

• Impaired insight

• Intelectual Insight

• True Insight



Internal Status

Conciousnes : compos mentis

Vital sign :

◦ Blood pressure : 100/70 mmHg

◦

Pulse rate : 80 x/mnt◦ Temperature : afebris

◦ RR : 20x/mnt



Head : normocephali

Eyes : anemic conjungtiva -/-, icteric sclera -/-, pupil

isocore

Neck : normal, no rigidity, no palpable lymph nodes

Thorax:

Cor : S 1,2 Sound and normal

Lung : vesicular sound, wheezing -/-, ronchi-/-

Abdomen : Pain (-) , normal peristaltic, tympany sound

Extremity : Warm acral, capp refill <2”,

RESUME



RESUME

Symptoms

Easily got angry

Refused to talk

Lack of sleep

Impairment

Poor utilization

of leisure timeDidn’t want towork even as ahousewife

Social

withdrawalself groomingstill good

Mental Status

Hypoactive

PassiveCoherentRemmingHallucination (+)auditory & visualIdea of reference

Thought ofwithdrawal



Differential Diagnose

F20.00 Schizofrenia Paranoid

- F25.10 Schizoaffective depressive

type

- F32.30 Severe Depressive episode

with psychotic symptoms.



Multiaxial Diagnose

Axis I :F25.1 Schizoaffective depressive type

Axis II :Introvert

Axis III :none

Axis IV :Desire for having a childAxis V :GAF admission 40-31





*PLANNING MANAGEMENT Pharmacothisapy

O Emergency therapy

O inj. Haloperidol 5 mg im

O Inj. Diazepam 5 mg iv For sedative

effect.

O Routine therapy

O Trifluoperazine 2 x 5mg poO Amitriptilin 1 x 25mg po



Psycho-education

Educate the patient and family after medication:

*Explain to patient’s family about mentaldisorder. There are many factors cause thesymptoms.

* Treat the patient according to the family’sability, don’t demand the patient more nor less.

*Help the patient when he needs it.

* Education of the family to encouragecommunication and understanding.



*PROGNOSIS

Ad vitam : ad bonam

Ad functionum : dubia ad bonam

Ad sanationum : dubia ad malam



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Morpot skizoafektif tipe depresi